Sperm Survival in Women. Motile Sperm in the Fundus and Tubes of Surgical Cases

Transcription

1 Sperm Survival in Women Motile Sperm in the Fundus and Tubes of Surgical Cases Boris B. Rubenstein, M.D., Ph.D.; Hermann Strauss, M.D.; Maurice L. Lazarus, M.D., and Henry Hankin, M.D. THE DURATION of sperm survival in the female genital tract is probably decisive in determining the length of the fertile period, since (1) the fertilizable life of the ovum is probably less than six hours;1, 4, 8, 1Q and (2) the chance that mating will occur just before or during ovulation is remote. Reliable data on sperm survival in women are scarce for any part of the genital tract above the cervical canal. The data of Huhner, Cary, and most recently of Cohen and Stein all indicate sperm survival in the cervical mucus to be generally about forty-eight hours although persistence of sperm motility up to seven days has been reported as an exceptional occurrence. 6 The only data on sperm survival in the fundus or tubes are those of Hart- man5 in macaques and of Pincus and Enzman in the rabbit. Weisman described a technic for obtaining fundal sperm but presented no data. This technic was attempted in 3 volunteer patients to whom the possible dangers were fully explained. The procedure below was followed at stated intervals after coitus. After exposure by speculum of the cervix uteri, it was wiped dry with several clean cotton swabs; the cervix was then painted with tincture of zephiran. The cervical canal was then wiped clean with sterile cotton swabs, also painted with zephiran, and again wiped with sterile cotton to remove the excess antiseptic. From the Department of Medicine and Division of Obstetrics & Gynecology, Michael Reese Hospital, Chicago, Ill.. The Surgical Cases were treated at the Franklin Boulevard Hospital, Chicago, Ill. This work was supported by a grant from the Committee on Human Reproduction of the National Research Council. 15

2 16 RUBENSTEIN, ET. AL. [Fertility & Sterility The cervical canal was then probed with a flexible uterine probe. Finally a cannula was introduced; 1 cc. of sterile saline was injected through the cannula into the fundus and withdrawn; approximately ~4 cc. was recovered. This was spread on a clean glass slide with a large oblong cover glass and searched for motile and nonmotile sperm. In the 5 trials on 3 patients, fundal sperm survival of 14, 24, 28, 36, and 36 hours was found. Each of these figures represents the longest survival recorded, e.g. motile sperm was found at 14 hours but not at 24 hours. These figures compare with in vitro room temperature sperm survivals (25 per cent motility) of 36, 36, 48, 48, 60 hours respectively of an aliquot from each specimen used. The experiments were not continued because endocervical or endometrial infection occurred in 2 of the 3 patients. Although the infection was readily controlled by antibiotic therapy, the hazard seemed excessive, and the procedure was discarded. At this stage of the investigation, it was evident that for further data, surgical cases would be necessary. The patients were young women without apparent gynecologic infection who were to undergo hysterectomy because of the presence of multiple or large fibroids, polyps, or extensive endometriosis. Whenever possible surgery was performed electively in the interval free from bleeding. Two cc. of semen containing about 200 million sperm were introduced vaginally (the semen sprayed on the cervix exposed by speculum) at the stated intervals prior to examination (see Table 1). Immediately after surgery, the cervix, fundus and tubes were separated, opened and separately washed with saline. The washings were examined microscopically for motile sperm. The data on the 51 surgical cases are presented in tabular form (Table 1). The number of motile sperm in each segment of the genital tract is indicated by the range 0 to ; + indicated an occasional motile sperm in the washing; + + indicated 1-2 motile sperm in each high dry field; and indicated more than 7 sperm in each high dry field. In some cases samples from one or more segments were not available for examination either because of incomplete removal or because too much blood in the washings made it impossible to determine whether motile sperm were present. The data presented in Table 1 indicate that motile sperm may be present in the fallopian tubes within half an hour after they reach the cervical os, even under the adverse conditions of surgical preparation; and motile sperm may still be present after fifty hours. While it is agreed that motility is only one of several factors determining the ability of sperm to fertilize ova,

3 TABLE 1. Summary of Data on Sperm Survival in the Surgical Cases Days Time after Case Age after last insemination Sperm motility No. (yr.) menstruation (hr.) Cervix Fundus Rt Lt l' t

4 18 RUBENSTEIN, ET. AL. [Fertility & Sterility motility is most readily observed and provides a useful, if approximate, index. The criticisms of motility as an index of fertility by Robson (p. 188), Moench, and Cary are well taken; nevertheless better criteria are not available. The data fail to support or refute the observations of Cohen and Stein regarding the longer survival of sperm during the "fertile period." It must be noted that surgery was not synchronized with vaginal smear changes, temperature variations, or cervical mucus; thus dating in the cycle is noncontributory except in a roughly approximate manner. Nevertheless, it is evident that sperm do penetrate the cervical mucus, pass through the fundus, and migrate through the tubes at all times in the cycle, and perhaps also after menopause, since sperm were found in the tubes in all ages from 27 years to 49 years. None was found in the tubes of the 2 oldest patients (50 and 52 years); but no great weight can be placed on findings in 2 cases. It is also noteworthy that the greatest concentrations of sperm were not always found either in the cervix or fundus. It may be that the washing technic did cause a relative dilution in the fundal segment; in 5 instances, however, sperm were not found in the fundal washings and were present in the washings from one of the tubes. The only 2 instances in which no motile sperm were found even in the cervix after 3 and 11 hours respectively (cases 5 and 30) were in patients with cervical polyps which probably occluded the passage. In 4 instances motile sperm were found in the cervix only; this finding had been expected to occur more frequently particularly at the longer intervals; instead it occurred sporadically at 3 and 12 hours when there was complete penetration in most instances. The four failures occurred on the third, ninth, fifteenth, and twenty-second days of the cycle, on two of which at least a watery cervical mucus allowing easy penetration was expected. While in case 20 Of hour) there was an extremely high tubal sperm concentration, this was true also in case 17 (15 hours). In none of the otter cases with the possible exception of case 7 (13 hours) was there an abundance of tubal sperm. The evidence of Pincus and Enzman that many sperm must be present for one to penetrate and fertilize an ovum, would indicate that either the artificial conditions of this experiment impeded sperm penetration, or else we were studying conditions in women of low fertility. The latter seems the more probable hypothesis since these were patients in whom hysterectomy had been advised.

5 Vol. 2, No.1, 1951] SPERM SURVIVAL IN WOMEN 19 SUMMARY Sperm migrate through the cervix, fundus, and fallopian tubes of women within thirty minutes after their introduction into the vagina. They may do this at any time in the menstrual cycle. Sperm may retain their motility in any and all parts of the female genital tract for at least fifty hours. The relation between motility and fertilizing ability was discussed. The importance of these data for determining the length of the fertile period of women was indicated. Further work at longer intervals and in women undergoing laparotomy without hysterectomy seems desirable. REFERENCES 1. Cary, W. H.: J. A. M. A. 106:2221, Cohen, M. R., and Stein, 1.: Fertility & Sterility (in press). 3. Hammond, F., and Marshall, F. H. A.: Reproduction in the Rabbit. Edinburgh, Oliver and Boyd, Hartman, C. G.: Time of Ovulation in Women. Baltimore, Williams and Wilkins, Hartman, C. G., in Sex and Internal Secretion (ed. 2). Baltimore, Williams and Wilkins, Huhner, M.: Sexual Disorders in the Male and Female (ed. 2). Philadelphia, F. A. Davis, Moench, G. 1.: Am. J. Obst. & Gynec. 38:153, Pincus, G., and Enzman, E. V.: J. Exp. BioI. 9:403, Robson, J. M.: Recent Advances in Sex and Reproductive Physiology (ed. 3). Philadelphia, Blakiston, Weisman, A. 1.: Am. J. Obst. & Gynec. 39:875,1940.